Kingston's Innovative Primary Care Model Aims to Address Physician Shortage
KINGSTON -- The sprawling second-floor office, located above a pharmacy on the city's main street, at one time was home to eight doctors serving the busy neighbourhood. But the physicians, with large patient rosters, were burning out and six were ready to retire, but couldn't find anyone willing to take over the practice.
Two years ago, they all left, the clinic shuttered, and 8,000 patients suddenly found themselves adrift -- joining about two million others across the province with no access to a family doctor.
It's not a problem unique to Kingston -- many communities across the province are grappling with a lack of primary care -- and it has emerged as a key issue in Ontario's Feb. 27 election. The opposition parties have hammered the PCs for being in power for seven years as the situation they inherited worsened, which even the government acknowledged has taken too long to fix and left too many without a family doctor.
But what has happened here since that clinic closed is a new model that has been able to attract physicians and taken thousands off the wait-list, a model that appears to have the support of the PCs, Liberals, and NDP.
That same Princess Street office reopened last summer as a "primary care home," as proposed by Dr. Jane Philpott, a former federal Liberal health minister and dean of the medical school at Queen's, recently hired by the PC government to help fix the province's health problems.
Her vision, outlined in her 2024 book Health for All -- which she calls the periwinkle model -- guarantees primary care for everyone based on their postal code, much like families being assigned a local school based on their address.
Two days before the provincial election campaign kicked off last week, the government and Philpott announced funding with a promise of primary care for all Ontarians by 2029, a total of $1.8 billion for every Ontarian to have a family doctor or primary care team within four years.
The government, however, says two million Ontarians need a physician, which is based on work by organizations like the Canadian Institute for Health Information, but the Ontario Medical Association says the number is 2.5 million and could rise to 4.4 million by 2026.
Last fall, Philpott spoke at the Liberal policy convention, and Leader Bonnie Crombie announced Thursday that if elected, she would spend $3 billion over four years to connect everyone with a family doctor. On Friday, NDP Leader Marit Stiles unveiled a $4.05 billion four-year plan to get all Ontarians access to a doctor or nurse practitioner, pledging more family health teams.
Philpott's model, based on similar ones in the Netherlands and the United Kingdom, ideally provide patients access to care seven days a week, taking pressure off emergency rooms and steering them away from walk-in clinics. They are treated by practitioners they know, and who know their histories; medical records are in one place, and once a full network of sites are in place, no one would worry about finding a family doctor if they move.
The Midtown Kingston Health Home opened last July, two years after a proposal by various health care partners in the city obtained funding from the provincial government.
At the health home, each family doctor works in a team with a nurse practitioner, sharing "provider pod" offices, with a host of in-demand services on-site -- diabetes care, COPD care, social worker, family health educator -- mostly for those within the K7M postal code. Community clinics for well baby care, sexual health, and quick STI testing are open to all. Practical assistance workers help patients who might need help co-ordinating insulin injections for their child while at school, or finding housing, or applying for a birth certificate.
It's hoping to secure funding to add occupational therapists, physiotherapists, mental health case management, and footcare, to make it more of a one-stop community hub for patients.
"The doctors, they were asking me all kinds of questions about my history and this and that, and I was just blown away, because my (previous) doctor would not engage with anything you would have asked him, and I always felt rushed," said lifelong Kingston resident Mario Borsato, 56, now a patient of the health home.
He and several of his family members had sought care at the original clinic for 20 years, and found themselves without a doctor for two years, so he knows the struggles of those who are still looking.
"If you don't have your health, you don't have nothing," he added. "And our family care (in the province) has gone down the tubes."
About 4,400 residents in the K7M postal code were on the wait-list through Health Care Connect, but it is estimated the actual need is double that. So far, the health home has rostered 1,418 patients and -- and treated another 1,535 through its various clinics -- and expects to have 4,000 patients signed up by the end of March and 8,000 patients by March 2026.
Winn Studsrud, a patient of the original clinic, was directed to the health home after seeking help with a prescription, but it wasn't until later that she realized she'd been taken on by a family doctor there, even though she doesn't live in the postal code.
"I freaking started crying," she said. "I couldn't stop smiling, actually. And I just kept saying 'thank you Lord, thank you Lord.' So honestly, it's like a miracle."
Dr. Mary Rowland, clinical lead, calls the health home "a really nice blend" and likens it to a secondary school, where "this school has the IB program, this school has French Immersion. We have a catchment, and we have these specialized programs for more supports for particular populations."
Dr. Eileen Nicolle, who moved with her family from Toronto to Kingston to be a part of the health home, said "you can provide the most holistic care and also take the time you need to see people ... I think if you take a more long-term approach, there's very much a cost saving and also a time saving because those problems that you don't deal with right up front, they come back."
Currently, the clinic is open five days a week with evening clinic hours, and has managed to attract five physicians so far, with one to come, plus locums, as well as three nurse practitioners.
Staff are on salary, have flexible hours, and a team-centred approach. Doctors like it because they don't have to run a business as they would setting up their own practice. They work more reasonable hours, and can leave when they want, "but they don't" because it's such an attractive setup, said Meghan O'Leary, director of clinical services for Kingston Community Health Centres.
Nurse Practitioner Edward Cho was the first hire, and saw the patient roster grow -- though initially there was some upset as those from the old clinic weren't necessarily able to re-register.
Cho values being paired with a doctor, because "there are more opportunities for patients to get follow-ups" in a timely manner.
"I'm not worried about my patients" when away, he added. "I always know they're covered. If there are urgent issues, I know they're well taken care of ... having two eyes, rather than one, is always a good thing."
Personally, he said the way the interdisciplinary model works gives him the "perfect work-life balance. I'm not stressed. I go home knowing that my inbox is taken care of, and I won't come back to 10 million messages. I finish all my charting on time."
For Nicolle, working with a male nurse practitioner gives patients choice. "Maybe they want to see a female for their Pap smear. Or maybe the men would rather see Ed for certain things. So it gives you a bit of diversity within the practice."
Research on team-based care has been shown to benefit patients' health and means a drop in hospitalizations and visits to the ER. Patients report higher levels of satisfaction and care, and health-care providers report higher job satisfaction and are less likely to burn out, says Jennifer Rayner, director of policy and research at the Alliance for Healthier Communities.
Raisa Deber, professor emeritus at the Institute of Health Policy, Management and Evaluation at the University of Toronto, said there are a number of team-based models in the province, and there must be flexibility in the system because what works in a large urban centre may not in a rural or remote area where it might be difficult to get additional services.
Dr. Tara Kiran, family physician and researcher at St. Michael's Hospital and the University of Toronto, works in a family health team that includes nurses, nurse practitioners, social workers, pharmacists, and others, focusing on a vulnerable population.
When more than one in five people in Canada don't have access to any primary care, with services varying by region, "we need to do things differently to try and even out the way services are provided ... so that we don't have the have and have-not, but rather, everybody has something."
The periwinkle model does address that and needs to be evaluated to see if it does attract doctors and is able to better clear wait-lists.
"There is a bit of an experiment here, and we do need to learn from it," Kiran added.
The Kingston model is part of a wider network that has a community board of governors, which is key, said Kate Mulligan, a professor at the Dalla Lana School of Public Health at the University of Toronto.
"If we're going to go to all the trouble of doing team-based primary care, which is the right next step, we shouldn't miss the opportunity to leverage the huge capacity that's there, to really connect that into our health care system," Mulligan said.
